Evolving patient portals, remote workforce challenges and tech at the bedside

Photo: Kerry Barker

Patient portal use and telehealth visits have changed dramatically since the COVID-19 pandemic turned the world, especially healthcare, upside down.

Kerry Barker, RN, manager, Epic services, at consulting firm CereCore, and a former ICU nurse and nursing instructor at Brigham Young University, left the bedside for the IT side. Her role now is multifaceted in that she assists with various parts of CereCore’s go-live implementations, stays up to date on policies and procedures, and works to keep patients at the forefront.

Healthcare IT News sat down with Barker to discuss her observations on the changes in patient portals and telehealth visits, the challenges and opportunities with remote workforces (especially as they pertain to go-live), how changes in the tech space affect the bedside (in a big way), and tips for healthcare leaders who want to better serve patients with EHRs and patient portal support.

Q. In your hands-on experience working with healthcare provider organizations and IT, what changes have you observed in patient portals and telehealth visits since COVID-19 broke?

A. COVID significantly changed the landscape for IT and the electronic health record. At the beginning of the surge, we had to electronically build new virtual departments for all of our COVID testing tents so our clinicians could place COVID testing orders, collect specimens and make sure they were linked to the right patients.

In addition, our IT teams set up technology in the tents to give clinicians access to computers for printing labels, etc. Some tents were located in parking lots of shopping centers. We had to ensure seamless reporting to get results into the respective patient portals and out to their primary care physicians.

Within the hospitals, units transformed overnight from one type of unit to another, which required extensive build and change. Post-anesthesia recovery units and med/surg floors were transformed into ICUs. Changes happened every day. We couldn’t wait weeks for things to go through normal change processes, but we still had to ensure a safe and secure build.

An immediate effort was required to change all of our physician practices over to telemedicine visits right away. Within one month, all of our multiple practices switched over to virtual visits. This included the ability to utilize mobile devices to connect patients at home with physicians in their offices. Physicians who were previously resistant to telemedicine and mobility solutions immediately began using their iPads and mobile phones to communicate with their patients so they could also be safe.

Though patient portals were always important in the past, many more patients became aware and began signing up. We also noticed a major upturn in patients wanting to receive all their medical information online.

When they had COVID testing, they wanted to see the results as soon as possible in their patient portal. We saw a dramatic increase in the number of users who were now vigilant in monitoring their information.

Since the peak of isolation and masking has passed, we don’t see a change in what our patients want. They still want to be able to utilize virtual visits. They still want access to everything in their medical record. They are clamoring for information and full transparency.

Q. What are the challenges and opportunities with a remote workforce, especially as they pertain to IT go-live?

A. During COVID, I participated in a go-live for a children’s hospital. Previously, for testing and preparation, we would assemble a large team in one spot to do testing and evaluate if our system was ready. We did not have that luxury.

I was functioning as the testing coordinator at the time. I had to figure out how we were going to communicate during testing and what tools we could use to share the information.

We had always used scripts for testing, but they were printed out and our testers would check off boxes and then pass them to the other person in the room. In addition, the testing team was working virtually from their homes, and they were located in every time zone across the U.S., including Alaska.

We first worked on rules of etiquette for testing and communicating during this period. Those rules were all agreed upon by our testing teams. We created spreadsheets shared on a Sharepoint site that identified which time zones people were in. All of our scripts and tracking tools were also shared online.

We utilized IMs and chat groups to give each testing team their own space for communicating. We also used tools to identify daily goals and the procedures for passing the script from person to person. We made sure to do thorough application testing, integrated testing, interface testing and any mapped record testing to vet out issues prior to go-live.

Another valuable tool was the ability to track and resolve any defects. Again, we went to our software experts to utilize ticketing systems for those defects and progress on solutions.

It was necessary to have a small contingent of staff onsite for our technical dress rehearsal. But this group was much smaller than any other go-lives we had done.

Most staff supporting this effort were virtual. We set up virtual meetings where we could chat on progress and deal with any issues that occurred. We utilized spreadsheets to track all equipment and ensure that all testing scenarios were completed.

For the actual go-live, we had a small onsite command center. The rest of the support team were virtual and were scheduled by shifts to ensure 24/7 coverage. The onsite individuals would round with the facility and then check back in to work with the team (who were on virtual meetings) to help with support and report any issues.

By doing this thorough testing and preparation, we were able to successfully launch our new facility and close the physical command center just one week after go-live and return to regular support levels after 12 days. I am happy to report that our go-live was labeled “the most boring go-live they ever had.”

Q. How have changes in the tech space affected the bedside?

A. So much has changed in the last 10 years in the tech available at the bedside.

Now our nurses carry mobile phones where they can chart. They can scan medications and patient armbands and administer medications from the phone. Using those same applications, they can administer blood products. They can chat securely with physicians. They can receive alerts about patient status updates.

We have eliminated the messy wall grease boards used by each unit where the charge nurse wrote the location of each patient and the assignments. Now we have electronic boards that are HIPAA friendly to help identify patient location and assignment as well as a number of other alerts to help with patient throughput.

There are predictive analytic models in our EHR that notify our clinicians in real time if their patients are at high risk for sepsis or at risk for readmission and other measures. We set alerts to help prompt our clinicians to make decisions on next steps for patient care.

We even have mobile inpatient patient portals at the bedside so that while hospitalized, patients can see their scheduled tests and labs and get results for themselves. They can also reach out to their physicians and communicate with them personally.

So much integration has changed to help our clinicians with less charting. We integrate vital signs and other pertinent medical information right from the bedside monitoring devices into the patient chart. Ventilator information from in the ICU and from anesthesia devices in the operating room is integrated with the patient chart.

Physicians and other providers that used to struggle with typing their notes or using a dictation system now can use voice recognition software to chart their notes. This is just a small glimpse into some of the items available.

Q. What are some tips for healthcare leaders who want to better serve patients with EHRs and patient portals?

A. Patient portals have been a challenge for many of our older population. Both mobile solutions and computer solutions need to be easy to use. There are multiple generations of people using our portals and we need to respond to the various levels of comfort with technology. Trying to figure out how to use it safely can be a struggle. Many are untrusting of electronics and reluctant to share and look up their data.

Population health is a broad concept that will increase in priority. With social media turning out fake news stories about how to maintain health, our portals are creating a source of information where patients can turn for correct information and education. Raising patient awareness about their medical issues and self-care will be important. We need to be collaborative to come up with solutions.

In the hospital setting and in the physician practices, we need to make it easier for staff to do their work and spend less time at the computer. Mobility solutions will be pushed to do more in order to keep our clinicians at the bedside and with the patient. Real-time solutions and information are in demand much like during COVID. Integrations are becoming increasingly important.

I think the biggest thing with EHRs and patient portals is to keep the imagination open for possibilities. So much is changing. Generations ago, the patient did whatever the doctor told them to do.

Newer generations question this and often seek out their own answers. Patients want to be more collaborative. I think the partnership between healthcare and patients will continue to increase in importance. Our customers are telling us they want to be a part of the decision-making process and we need to listen.

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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